=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407988793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUBEN REYES SANTANA DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 356 S VERMONT AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90020-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-386-1418
-----------------------------------------------------
Fax | 213-386-1417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 356 S VERMONT AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90020-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-386-1418
-----------------------------------------------------
Fax | 213-386-1417
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 37495
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------